Building-Related Illness (BRI) is a discrete, identifiable disease or illness that can be traced to a specific pollutant or source within a building. In contrast, the term Sick Building Syndrome (SBS) is used to describe situations in which building occupants experience acute health and comfort effects that appear to be linked to time spent in a building, but no specific illness or cause can be identified. Both syndromes are associated with immediate or potential health problems and are of particular concern as it is estimated that most people spend as much as 90% of their time indoors. It is indoors where EPA studies have shown that the levels of pollutants can be 2-5 times, and occasionally, more than 100 times higher than outdoor levels.
The American Lung Association recently documented a decrease in motivation, performance, and productivity among office workers and school children in relation to poor indoor air quality within buildings. Their evidence involving office workers suggests that when individuals experience only two symptoms of discomfort, they begin to perceive a reduction in their own performance. This perception increases as the number of symptoms increases, averaging 3% loss with three symptoms, and an 8% loss with five symptoms.
The EPA stated in 1991, “The term “Sick Building Syndrome” is used to describe situations in which building occupants experience acute health and discomfort effects that appear to be linked to time spent in a building, but no specific illness or cause can be identified. The complaints can be localized in a particular room or zone, or can be widespread throughout the building. In contrast, the term “Building Related Illness” is used when symptoms can be attributed directly to airborne building contaminants.” The EPA has just published a new reference document, “Mold Remediation in Schools and Commercial Buildings” (EPA 402-K-01-001). This publication is the governmental standard for mold and treatment of commercial buildings. The EPA states that mold in commercial buildings contaminates or destroys everything it grows on including building walls, air conditioning, ceiling and carpeting, etc.
Identifying “Sick Buildings” can be difficult. Identifying the actual cause of the ‘sickness’ can be even more difficult. Molds are a good example of the problems encountered when attempting to identify the source of pollutants. They are present everywhere, both indoors and outdoors. Their effects on people are quite random, some experience extreme symptoms, while others have only minor reactions.
Those who suffer from asthma, hay fever, or other allergies are at a particularly high risk for Building-Related Illnesses. Symptoms can include one or more of the following (ranging from mild to acute): headache; eye, nose or throat irritation; dry or itchy skin; dizziness and nausea; difficulty in concentrating; fatigue; and sensitivity to odors. In the case of Building Related Illnesses, the cause of the symptoms is not obvious, i.e., a cold or flu. The symptoms can linger for several weeks or more. Most of the affected people experience relief after leaving the building. If inhabitants of a building experience these symptoms, then the building's environment can be a factor.
Unhealthy indoor air associated with Sick Building Syndrome and Building Related Illnesses can come from a variety of sources. Most common are dust mites (and their feces), mold, off-gassing chemicals (from carpets, paint, glues and plastics), and natural sources (decaying plants or animals, radon, animals and their dander, people). Many substances can infiltrate our indoor airspaces and then accumulate to a point that leads to illness.
Molds (fungi) can often be associated with Sick Building Syndrome and Building-Related Illnesses. According to an Environmental Protection Agency (EPA) bulletin published in March 2001, “Molds can be found almost anywhere; they can grow on virtually any organic substance, as long as moisture and oxygen are present. There are molds that can grow on wood, paper, carpet, foods, and insulation. When excessive moisture accumulates in buildings or on building materials, mold growth will often occur, particularly if the moisture problem remains undiscovered or unaddressed.”
Indoors and outdoors, mold is present everywhere. The term mold applies to the microscopic members of the Fungi kingdom. It is a fuzzy, cobweb-like growth produced on organic matter. Mold has no ability to ‘fix’ carbon using chlorophyll, so it relies on some type of organic material as a food source. It can spread rapidly, forming the mycelium (fungal body), which is made up of a fine network of filaments (hyphae). The mycelium produces other clusters of root like hyphae, called rhizoids, which penetrate the organic material, secreting enzymes and absorbing water and the digested sugars and starches. Other clusters of hyphae called sporangiophores then reach upward, forming sporangia (knoblike spore cases), which bear the particular color of the mold species. Upon ripening, the sporangia break open and the windborne spores land elsewhere to reproduce asexually. If they find themselves in a less than ideal situation (not sufficient food, water, etc) molds are likely to switch to a nonsexual method of reproduction (one not involving swapping or combining of genetic material) for the duration. This can make molds hard to identify, since species are classified by their sexual characteristics (e.g., kind of spore cell wall, spore-producing cells, and sacs that store cells). Worldwide there are more than 100,000 species of mold, with at least 1,000 species common in the United States. Some of the most commonly found are species of Cladosporium, Penicillium, and Aspergillus. Mold can be found almost everywhere and it can grow on virtually any organic substance. Mold is most likely to grow where there is water or dampness, such as bathrooms, attics, and basements.
Most types of mold commonly encountered are not hazardous to healthy individuals. However, there are some that have achieved recent notoriety that are strongly toxic such as Stachybotrys. Stachybotrys is not common but can be very harmful when encountered in quantity. Others, like Aspergillus, can be dangerous as well. Aspergillosis is a lung disease suffered generally by immune-compromised people. In this disease, the Aspergillus mold actually grows in a person's lungs and can cause death. In general, too much exposure to even common molds can cause or worsen conditions such as asthma, hay fever, or other allergies. Common symptoms of overexposure to mold are cough, congestion, runny nose, eye irritation, and aggravation of asthma. More serious health effects, such as fevers and breathing problems, can occur depending on the amount of exposure and person's individual vulnerability.
When moldy material becomes damaged or disturbed, spores (reproductive bodies similar to seeds) can be released into the air. Exposure can occur if people inhale the spores, directly handle moldy materials, or accidentally ingest it. Mold can sometimes produce chemicals called Mycotoxins, which can also cause illness to sensitive people.
All molds must have water to grow. Mold can grow almost anywhere there is water damage, high humidity, or dampness. Removing the source of moisture is critical to preventing mold growth. Typical water sources utilized by mold in residential environments include air conditioner condensers, roof leaks, pipe leaks, sprinklers adjacent to an outside wall, and the like.
Stachybotrys Chartarum (also known as Stachybotrys atra) is a type of mold that has been associated with health effects in people. It is a greenish-black mold that can grow on materials with a high cellulose content, such as drywall, hanging ceilings and wood—that has been chronically moist or water damaged, due to excessive humidity, water leaks, condensation, or flooding. Numerous molds are black in appearance, but are not Stachybotrys. For example, the black mold commonly found between bathroom tiles is not Stachybotrys. Stachybotrys can only be positively identified via laboratory testing.
Indoor levels of Stachybotrys are typically low; however, as with other types of mold, at higher concentrations health effects can occur. These include allergic rhinitis (cold-like symptoms), dermatitis (rashes), sinusitis, conjunctivitis, and aggravation of asthma. Some related symptoms are general, such as inability to concentrate and fatigue. Usually, symptoms disappear after the contamination is removed.
There has been some evidence linking Stachybotrys with pulmonary hemosiderosis in infants who are generally less than six months old. Pulmonary hemosiderosis is an uncommon condition that results from bleeding in the lungs. In studies of pulmonary hemosiderosis, the exposure to Stachybotrys came from highly contaminated homes, where infants were continually exposed over a long period of time. Individuals exposed to the mold who exhibit symptoms characteristic of mold exposure should seek appropriate medical attention.
Visible mold can be sampled and analyzed by laboratories specializing in microbiology. However, these tests can be expensive—from hundreds to thousands of dollars. Even if a building is tested for mold, it is difficult to determine at what levels health effects can possibly occur. Therefore, it is important to attack any mold infestation. For small infestations, bleach and water can be effective to kill the mold growth. For larger infestations, more extensive treatment wherein large areas of a building or the whole building are treated can be necessary to kill all of the mold. Once the mold is destroyed, the next step is to find the mold's source of water. Mold will not grow without water, so to prevent its return, its source of water must be located and eliminated. In order to adequately remediate a mold infestation, it is necessary to both destroy the mold and to eliminate the mold's source of water.
While mold infestation itself is not becoming more common, knowledge of it and the problems it can cause is becoming more widely disseminated. In the last few years there have been many widely publicized cases concerning sicknesses caused by mold and the multi-million dollar settlements awarded to those who suffered the consequences of mold toxicity. As well, there have been reports of individuals who have burned their houses down because that was a cheaper solution than remediation of the mold-caused damage. Removal of moldy materials can involve procedures similar to those associated with removal of toxic waste material, such as asbestos, which means that any remediation can be extremely expensive to conduct. It is because of all this publicity that there is an appearance that mold has become more prevalent when in fact it has only become more recognized for its undesirable qualities.
Other pathogens, allergens, and odor-causing agents, e.g., dust mite feces, fungi, spores, pollen, mildew, bacteria, viruses, amoebas, fragments of plant materials, human and animal dander, proteins that that cause allergic reaction such as the ones in dust mite feces and animal dander, feather dust, litter dust, tobacco smoke, smoke from fires, volatile organic compounds, and other bio-aerosols and inorganic aerosols and gases, can also be the cause of Building Related Illnesses. For example, the feces of household dust mites can cause allergic reactions. A gram of house dust (approximately half of a teaspoon) can contain as many as 1,000 dust mites. That same amount of dust could hold over 250,000 of their fecal pellets. Once airborne, dried dust mite droppings are so small that they are easily inhaled causing allergic reactions in many people. These reactions can range from sneezing, coughing, itchy eyes and sniffles to asthma, eczema, even snoring. House dust mites are related to spiders. They are eight legged creatures invisible to the human eye. They survive by eating dead skin cells. A dust mite will produce 20 fecal pellets per day, which is 200 times its own body weight, during its short lifetime. The greatest number of dust mites in the home is usually found in the bedroom, specifically in the bedding and pillow. The skin and moisture shed each night provide ideal conditions for their growth. Millions of mites can be present in bedding, and up to 10% of a two-year-old pillow's weight can be made up of house dust mites and their droppings.
Pets are another source of allergens. Household pets are the most common source of allergic reactions to children. It is estimated that 10 million animal owners may be allergic to their animals, and 20% to 30% of the people who have asthma are also allergic to animals. Many people react to animal allergies in extremely different manners. For some people, animal odors, dander, saliva, and urine can cause allergic reactions. Animal fur can also collect outdoor pollens, mold spores, and other outdoor allergens that are then brought indoors. A recent study reviewed by the American Academy of Allergy, Asthma and Immunology, indicated that approximately 80% of the animal owners surveyed keep their animals indoors most of the time. These findings may help explain why allergy symptoms, such as itchy and watery eyes, sneezing, coughing, wheezing and hives in allergic children and adults, worsen with continued exposure to animals.
The American Lung Association's “Health House Project” stated that “[a]ccording to a recent study published in Pediatrics magazine, asthma cases could drop nearly 40% among America children under age 6 if susceptible youngsters did not have pets or other allergy triggers in their home. The study also found that children with animal allergies were 24 times more likely to have asthma than those without such allergies.”
One of the more difficult problems with allergies to animals is it can take two years or more to develop in a home and may not subside until 6 months or more after the animal has been removed from the home. Carpeting and furniture can act as reservoirs for animal dander and allergens. The animal dander can become a food source for common household dust mites. These pest and allergens can also find their way throughout the homes' heating and air condition system.
The elderly, young children and infants in particular, are especially susceptible to negative reactions to allergens and pathogens. Many magazines, such as Harper's Bazaar and Parent's have articles on how to clean and prepare a home for a new infant. Harper's has a Wellness Report that contains a home purity checklist that cites mold, dust mites, and animal dander as major home health concerns. As mentioned above, of major concern to infants is animal dander that can trigger sniffling, stuffy noses, and sneezing and water eyes. Dust mites are a known trigger for asthma, and found everywhere.
Of serious concern to infants is mold, which comes from persistent leaks from air conditioners and plumbing that can lead to airborne mold, which aggravates allergies. Some indoor molds have the potential to produce extremely potent toxins called Mycotoxins. Mycotoxins are readily absorbed by the intestinal lining, airways, and skin. Molds that produce potent toxins have been associated with acute pulmonary hemorrhage among 37 infants from the Cleveland, Ohio, area between 1993 and 1998. Twelve of these children died. As stated by Dr. Henry Fishman M. D. P. C., Diplomat American Board of Allergy and Immunology, American Board of Internal Medicine and National Board of Medical Examiners, “There is a body of evidence that indoor allergies, particularly dust mites, may cause asthma in some infants. Without the dust mite sensitivity, asthma does not develop. Untreated asthma in pregnant women can lead to early deliveries, miscarriages, and low birth weight infants. Indoor allergens can make this worse. Also allergies can lead to infections. Kids' immune systems cannot handle the infections burden as well as an adult. So kids with allergies have trouble with infections which can bother their tiny lungs. In other words, in some sensitive kids, allergies have a huge impact on their nose, sinuses and lungs.”
Commercial buildings often present special concerns regarding Sick Building Syndrome, Building Related Illnesses. According to Business Week Magazine, today's business office is home to as many as 30 different volatile organic chemicals released by building materials, furnishing and office equipment. Some of the biggest offenders are sealed windows, carpets and padding, carcinogenic cleaning products, the office restroom, cafeterias and kitchen areas, and building renovations. Many people work in enclosed building or offices. Not being able to open windows means you do not always have enough fresh air to circulate within the building. Many carpets, rugs, and paddings are made in part from petrochemicals. An example is formaldehyde odor which is often noticed for a few weeks after new carpet is installed. The same is true with products used in the interiors of new cars. The odor being released is called “out gassing.” It often affects people with allergies or sensitive skin. There are over 70,000 identified chemical cleaning products on the market that are used to clean buildings and offices. Some of them contain toxic solvents that, it is claimed, are considered safe when used properly. Clogged toilets and flooded restrooms can create toxic mold and airborne mold spores in area that are difficult to continually inspect. Many buildings have common lunch and food areas that must be maintained within local Health Department standards. Office construction and remodeling can cause mold to spread throughout a building in the matter of a few minutes according to EPA testing. Mold and contaminated dust can cause employees serious health problems.
Problems associated with Sick Building Syndrome have been extensively reported in the media. Media coverage has shown buildings being condemned; structures being burned down to destroy toxic and mold contaminates. Business and consumer magazines such as Business Week, Time, The Wall Street Journal, Reader's Digest and People Magazine are reporting insurance claims cases and medical awards to people that have been harmed by these toxic conditions. In every case, the courts decisions held that the condition could and should have been treat earlier by the building owners or insurance companies. Television networks are giving coverage to this problem as a major health and business issue.
Erin Brockovich, antipollution crusader, was featured on CBS News broadcast “48 Hours,” because her home is infested with the toxic stachybotrys mold. NBC Nightly News coverage of the Melinda Ballard's toxic infestation case stated “A Texas jury decided her insurer committed fraud and mishandled her claim, awarding her $32 million.”
In the August, 2000 issue of Claims Magazine, an insurance industry publication, “a jury recently awarded more than $40 million in personal injury claims. There were over 200 workers' compensation claims and at least 180 separate lawsuits. Previously, such lofty figures were seen only in asbestos or drug-related class actions. Now, we are starting to hear 11-digit figures mentioned in litigation concerning the lowly mold fungi.”
The Lawyers Weekly USA, a national publication, stated in their Oct. 6, 2000 edition, that claims for personal injury and property damage caused by mold growing inside buildings are on the rise, and one of the “hottest areas” in construction defect and toxic tort law.
The United Press International reports in a feature story titled “Toxic mold a growing legal issue” that, “Mold contamination claims were virtually unheard of a few years ago, but people are becoming more aware of indoor air quality issues because of the expanding scientific and medical knowledge of the toxic effects of mold.